That is an argument over semantics, and what I meant when I said fatigue is a misleading word to use. Adrenal dysregulation is a better umbrella term to describe the majority of cases in the AF forum. Also, you highlight physical stressors, but what about mental and emotional stress? The following articles show how they can also cause adrenal (or a broader term to encompass both adrenal and thyroid disorders would be HPA axis) dysfunction: